GI Disorders and Shock Flashcards
1
Q
What are the causes of vomiting?
A
Stimulation of the medullary vomiting center or gastric/intestinal distension
2
Q
What are the two distinct parts of the brain that control symptoms of vomiting?
A
Vomiting center
Chemoreceptor zone
3
Q
What are the causes of dysphagia?
A
Neuro: Stroke
Structural: Cancer, autoimmune, achalasia
4
Q
What are the manifestations of dysphagia?
A
Choking, Coughing, risk of aspiration
5
Q
What is mallory-weiss syndrome?
A
Longitudinal tears in the esophagus from vomiting
6
Q
In what demographic of patients do we see Mallory-Weiss syndrome?
A
Individuals with heavy alcohol intake
7
Q
What is a hiatal hernia?
A
A prorusion of lower esophageal shpincter and part of stomach above the diaphram
8
Q
What are the two forms of hiatal hernias?
A
Sliding
Rolling (paraesophageal)
9
Q
Which hiatal hernia is worse?
A
Rolling (paraesophageal) because the stomach can become necrotic or food can become trapped inside
10
Q
What are the manifestations of GERD?
A
Pyrosis usually 30-60 min after eating
Possible respiratory symptoms from aspiration of acid
11
Q
What are some complications of GERD?
A
Strictures
Barrett Esophagus
12
Q
What is a stricture?
A
Scar tissue
Smooth muscle spasms and edema may cause stenosis of lower esophageal sphincter
13
Q
What is Barrett Esophagus?
A
Chronic inflammatory damage from acid exposure that leads to metaplasia of cells (Risk of cancer)
14
Q
What is gastritis?
A
Inflammation of the gastric mucosa
15
Q
What are the common causes of gastritis?
A
Aspirin
NSAIDS
Alcohol
Bacterial Toxins
16
Q
How does H. Pylori cause gastritis?
A
The gram negative rods colonize the mucosal layer. Their flagella facilitate burrowing into the submucosa and the bacteria secretes urease, which buffers the surrounding acid
17
Q
What is Peptic ulcer disease (PUD)?
A
Ulcer related disorders in the upper GI tract
Can develop in stomach or duodenum
18
Q
What causes PUD?
A
NSAIDS
H. Pylori
GERD
Smoking
No Silly Green Hats
19
Q
What are the manifestations of PUD?
A
Discomfort
Pain
Burning
Cramping
Gnawing quality
20
Q
When are the manifestations of PUD normally felt?
A
When stomach or duodenum is empty
21
Q
What are the complications of PUD?
A
Bleeding (esp if ulcer erodes deep in submucosa)
Hematemesis (vomiting of blood)
Melena (dark feces b/c of blood)
Perforation (high risk of peritonitis)
Outlet obstruction
Big Helmeted Men on Puppies
22
Q
What is Irritable bowel syndrome?
A
Persistent or recurrent symptoms of intestinal dysfunction without physical abnormalities involving increased motility and intestinal contraction
23
Q
Symptoms of IBS are normally relieved in what way?
A
By defecation
24
Q
How may people have IBS?
A
10-15% of US pop
Women more than men
25
What is Inflammatory bowel disease?
Its a general term for two related inflammatory intestinal disorders-Crohn's and Ulcerative Colitis
26
What are the shared characteristics of IBD (Crohn's and Ulcerative Colitis)?
-Bowel inflammation
-Inflammatory Cell activation
-Remission/exacerbations
-Systemic Manifestations
BIRS
27
What are the causes of Crohn's/Ulcerative Colitis?
Causitive agent is unknown, however there seems to be a familial occurance
28
How are Crohn's and Ulcerative Colitis different?
Crohn's: Normally more severe, affects small intestine and start of large intestine, causes patches of inflammation that damage multiple layers
Ulcerative Colitis: Primarily causes inflammation of rectum & colon, and inflammation is continious->only effects innermost layer
29
What are the manifestations of Ulcerative colitis?
-Chronic inflam. of colon
-Relapses marked by diarrhea with blood and mucous in stool
-Abdominal cramping
-Weakness
-Fatigue
30
What is a diverticulum?
Outpouching of a hollow structure of the body
31
What is Diverticulosis?
Diverticula are present in the colon but not inflamed
32
What is diverticulitis?
Inflammation with perforation of diverticula that causes pain and tenderness
33
What is appendicitis?
Inflammation of the 6-9 cm tubular pouch at the ileocecal junction
34
What are the signs and symptoms of appendicitis?
RLQ pain over 1-2 days
N/V
Rebound tenderness
Low grade fever
Leukocytosis
35
What is peritonitis?
Inflammation of the peritoneum that can be acute or chronic
36
What are the causes of peritonitis?
Ruptured appendix
Perforated ulcer
Penetrating abdominal wounds
37
What occurs during the initial infection in peritonitis?
Exudate with fibrin surrounds and isolates initial infection by forming adhesions
38
What occurs after initial infection in peritonitis?
More general problems occurs such as:
Paralytic ileus
Loss of F&E into caviyu
Tachycardia
Hypoension
WBC increase
Fever
39
A polyp in the colon can cause?
If it becomes malignant it can cause colon cancer
40
What are the manifestations of colorectal tumors? What is important to remember about these?
It is important to remember that tumors are usually present long term before causing manifestations of bleeding, change in bowel habits and pain
41
What are the tests for colon cancer?
Stool based testing
Colonoscopies
42
What are the manifestations of a bowel obstruction?
Pain
Constipation
Abdominal distension
FVD
Vomiting
43
What are the 'mechanical' bowel obstructions?
Hernias
Intussusception (inversion of one portion of intestine with another)
Post-op adhesions
Foreign bodies
Volvulus (twisting of intestine)
44
What are the 'paralytic' (Functional) types of bowel obstructions?
Occurs from neurogenic or muscular impairment and is common after abdominal surgery
45
What is hyperbilirubinemia?
Jaundice-bilirubin accumulation
46
What are the 3 cateogories than hyperbilirubinemia can be grouped into?
Pre-hepatic
Intra-hepatic
Post-hepatic
47
What can cause pre-hepatic hyperbilirubinemia?
Any RBC disorder causing excessive hemolysis
48
What are the causes of intrahepatic hyperbilirubinemia
viral hepatitis
alcoholic cirrhosis, primary biliary cirrhosis
drug induced jaundice alcoholic hepatitis
49
What are the causes of post-hepatic hyperbilirubinemia?
biliary obstruction by a stone in the common bile duct or by carcinoma of the pancreas.
50
What are the causes of hepatitis?
Viruses
Alcohol abuse
Drugs
Autoimmune conditions
51
Which are the most common types of viral hepatitis?
A
B
C
52
What is the transmission route for Hep A?
Fecal/Oral
53
What is the incubation period for hep A?
15-30 days
54
When are most individuals infectious with hep A?
in the first two weeks, overlapping with prodromial period
55
What are the signs and symptoms of hep A?
Acute onset of:
Nausea
Abdominal bloating
General malaise
Jaundice
Jackie Generally (has) No Abs
56
Which forms of common viral hepatitis have a vaccine?
A, b
57
What is the route of transmission of Hep B?
Parenteral
Transmission through sexual fluids
58
Which type of effects does hep B have, acute or chronic?
Both
59
What is the incubation period of hep B?
60-90 days
60
25% of people with Hep B will progress to?
What about the people who don't progress?
Cirrhosis and liver failures
The other 75% will still have latent hep B and are called carriers
61
Which type of viral hepatitis is the most common cause of chronic hepatitis, cirrhosis and liver cancer?
Hep C
62
What are the transmission routes for Hep C?
Bloodborne pathogens
IV drug use
Needle sticks
Small risk through receptive anal intercourse
63
What is the incubation period of hep C?
6-12 weeks
64
What type of symptoms normally appear with initial hep C infection?
Minimal symptoms
65
20-25% of patients with hep C will?
Clear the infection
66
What is the cure rate for hep C infection?
95%
67
How is hep C normally discovered?
Through routine screening
68
______ of alcohol is metabolized in the stomach, while __________ is metabolized in the?
20% in the stomach
80-90% in the liver
69
What are the 3 stages of liver damage from alcohol?
Fatty liver disease -> Hepatitis->Cirrhosis
70
What is fatty liver disease?
Accumulation of fat molecules within the hepatocytes that cause the liver to enlarge and develop a yellow color and shiny, greasy appearance
71
What are the variables for fatty liver disease?
Amount of EtOH
Overall Diet
Amount of overall body fat
72
What is alcoholic hepatitis?
Inflammation and necrosis of hepatocytes
73
What are the signs and symptoms of alcoholic hepatitis?
Jaundice
Abdominal tenderness
Pain
Swelling
Nausea
74
What is cirrhosis?
Chronic disease of the liver than can result from viral hepatitis, biliary disease, EtOH abuse
75
What happens to the liver in cirrhosis?
Fibrosis and scarring occur
Abnormal liver cells regnerate
Nodules of varying size develop
76
What do the cirrhosis fibroids and nodules interfere with?
General function
Scarred/Stiffness impairs blood flow
Hepatocytes are impaired
77
Cirrhosis may progress to?
Functional liver failure
Portal hypertension
78
What are the manifestations of cirrhosis?
Manifestations mostly due to circulatory congestion (portal hypertension) and reduced liver function
79
What is portal hypertension?
Sustained elevated pressure in Portal vein >22mmHg
80
What are the causes of portal hypertension?
Prehepatic: Venous clots in vein
Intrahepatic: Cirrhosis
Posthepatic: Blockage in hepatic vein, right sided heart failure
81
What are the complications of Portal hypertension?
Ascities
Splenomegaly
Portosystemic shunts
A person the portal hypertension can have a swollen spleen, swollen belly and blood has to move around these.
82
Ascities in a very late sign of portal hypertension, cirrhosis and liver failure. Why?
Because the liver isn't functioning, decreased albumin lowers capillary oncotic pressure, while sustained pressure in portal vein pushes back into capillaries increasing capillary hydrostatic pressure. This pushing out causes 3rd spacing
83
Why is splenomegaly a complication of portal hypertension?
Spleen enlargement can occur due to excess blood volume and pressure
Blood can also become congested and trapped
84
Portosystemic shunts are a complication of portal hypertension. Why?
the collateral pathways/side channels occur because of increased pressure in the venous system.
Especially dangerous are esophageal varicies
85
What are esophageal varicies?
Collateral pathways on the esophagous due to increased pressure in venous system.
Very dangerous if they rupture->considered an acute bleed.
86
What is liver failure?
The end stage of various liver diseases that develops when the liver is at 10-20% capacity
87
What are the hematological effects of liver failure?
Decrease in RBC and platelets
Clotting factors effected
88
What are the endocrine effects of liver failure?
Glycogen production impaired
Bile production ceases
Androgen and estrogen hormones effected
89
What are the dermatological effects of liver failure?
Visible jaundice of skin
Itching due to bilirubin buildup
90
What is hepatic encephalopthy?
A complication of liver failure where ammonia builds up in blood and can enter the CNS causing liver related brain damage
91
What are the risk factors for cholelithiasis (gallstones made of cholesterol)?
Increased concentration in bile
Female gender
Overweight
White
40's
92
What is cholesystitis?
Inflammation of the gallbladder often due to cholelithiasis
93
What are the symptoms of cholesystitis?
PAIN
Vominting associated with eating (esp a meal with high fat content)
94
What is acute pancreatitis?
Active pancreatic enzymes are released into the pancrease and surrounding tissue
95
What are the common causes of acute pancreatitis?
Gallbladder issues
Excessive EtOH intake
96
What are the symptoms of acute pancreatitis?
Severe, radiating abdominal pain and distension
Fluid may be lost into retroperitoneal cavity or abdomincal cavity
*Pts will be in fetal position
97
What is chronic pancreatitis?
Gradual, permanent damage of pancreas tissue with repeated episodes similar to acute pancreatitis
98
What is the most common cause of chronic pancreatitis?
Long term alcohol abuse
99
The accumulated damage from chronic pancreatitis can eventually?
Permanently impair endocrine and exocrine function
100
Shock is also known as?
Circulatory Failure
101
Shock is?
An acute failure of the circulatory system to provide the body tissues with adequate blood supply/flow
102
Shock results in?
Decreased perfusion of all body organs, tissues, and cells
103
What do the manifestations of shock result from?
Hypoxic injury of tissues and organs and the compensatory mechanisms of the body
104
Key features across all shock are?
Hypotension
Reduced BP
Low perfusion through body
105
Cardiogenic shock is?
Reduction in cardiac function that begins at heart because the heart is failing to adequately pump blood.
106
Hypovolemic shock is?
Loss of blood volume from fluid volume deficit->
An acute loss of 15-20% or greater IVF
107
Obstructive shock is?
Blockage of blood flow through the circulatory system (ex: massive blood clot in circulatory system)
108
Distributive shock is?
massive systemic vasodilation expands the vascular compartment such that blood volume cannot fill the space
(neurogenic, anaphylatic and septic)
109
What are the signs of cardiogenic shock?
Decreased cardiac output and signs of decreased perfusion despite appropriate intravascular volume
Suddenly reduced EF%, CO and BP
110
What are the most common causes of cardiogenic shock?
Myocardial infarction (stemi->effecting left ventricle)
Serious dysrythmias, cardiac tamponde, acute valve disorders
111
What is one of the biggest manifestations of cardiogenic shock?
EDV (preload) keeps increasing as the heart (usually LV) fails.
112
The manifestations of cardiogenic shock are similar to?
Acute heart failure
BP drop
Pulse pressure decrease
Crackles in lungs due to fluid
Neurologic changes
Decreased LOC
113
What are the causes of Hypovolemic shock?
External or internal hemorrhage
Loss of plasma
Loss of ECF (ascities)
Excessive third spacing
114
Compensations of hypovolemic shock are targeted towards _____________ and ____________.
Maintaining cardiac output
Maintaining blood volume
115
Fluid Volume Deficit/Hypovolemic Shock symptoms:
Mild
Thirst
Increased HR
BP normal
Peripheral Vasoconstriction
Mild neuro changes
Dry mucous membranes
116
Fluid Volume Deficit/Hypovolemic Shock symptoms:
Moderate
Weakened pulses
Decreased urine ouput
Tachycardia (significant)
Hypotension (worsening)
Hyperventilation
Apathy
Stupor
117
Fluid Volume Deficit/Hypovolemic Shock symptoms:
Severe
Peripheral veins collapse
Severe hypotension
Cool, clammy skin
Little to no urine output
Coma
118
Blood pressure is not always a reliable way to stage shock, but what is?
Hourly urine output is a better indicator of abdominal/central organ perfusion because the kidneys are one of the last places blood will be diverted
119
What is the treatment of hypovolemic shock?
Restore plasma blood vol
120
What are the two main causes of distributive shock?
Impaired or absent sympathetic NS function
Systemic release of vasodilator chemicals
121
Causes of neurogenic distributive shock are?
Reduced or blocked sympathetic output
122
Causes of anaphylatic distributive shock are?
A systemic type 1 reaction
123
Causes of septic distributive shock are?
Systemic inflammatory response to severe infection
124
The most common type of distributive shock is?
septic
125
What is systemic inflammatory reponse syndrome (SIRS)>
A systemic inflammatory response often due to a bloodstream infection
126
What are the criteria for SIRS?
Increased or decreased temp
Tachycardia
Tachypnea or hypocapnia
Leuopenia or leukocytosis
Elevated lactate level (due to anerobic metabolism)
127
What is the progression from infection to septic shock?
Septicemia->SIRS->Severe sepsis->Septic shock
128
Infection + SIRS=
Sepsis
129
What is the most frequent cause of septic shock?
Gram negative bacteria infecion
130
Signs of shock + confirmed septicemia =
Septic shock
131
The gram negative circulatory infection which leads to sepsis causes?
Systemic vasodilation
Disruption of caogulation/anticoagulation cascades
132
What are the early manifestations of septic shock?
Fever
Vasodilation
Warm skin
Mild tachypnea/resp.alkolosis
Neuro changes
133
What are the later manifestations of septic shock?
Increased HR
Decreased BP
Decreased kidney function
Eventual multiple organ dysfuction if left untreated
134
General Complications of Shock?
ALI/ARDS
Acute kidney injury
GI injury -lack of perfusion
DIC
MODS
135
What is DIC?
Disseminated intravascular coagulation.
Very complex bleeding disorder that 50-60% of pts with septic shock get.
Bascially in some places they are clotting and some places they are hemorrhaging
